Trudeau Health Systems (THS), High Peaks Hospice (HPH), and Adirondack Medical Center (AMC) have undertaken a joint venture to research the implementation of an electronic medical record in the medical community. The partners' location, in the heart of the rural Adirondack Mountains, presents unique barriers for healthcare organizations, particularly those with multiple locations or those servicing patients in their homes. The extreme weather and considerable distances between communities via local roads over mountainous terrain contribute to inefficiencies in the movement of patients and their records. Effective utilization of technology has become increasingly important in providing patients with the highest quality of care possible. From the clinical perspective, the organizations are looking to improve the quality of care through better documentation and care management; improve care with fewer errors through the use of electronic ordering, including decision support, automatic routing of orders to pharmacies and labs, and better tracking of test orders and results; and identify a system that will allow for the seamless exchange of clinical information throughout the medical community. From the administrative perspective, the organizations are looking to increase timesaving and office efficiency from improved viewing, chart availability, organization and legibility; realize cost savings associated with reduced staff and transcription costs; assure compliance with federal, state, and local mandates, including HIPAA; and achieve the financial and timesaving benefits of having an integrated EMR and billing software program. This venture involves the partnership of three community provider organizations dedicated to the delivery of high-quality, cost-effective healthcare. The goal is to encourage community-wide data exchange, and foster the adoption of an Electronic Medical Record.